Abud Bakari MD on Balancing Health in the Midst of it All

Hello, hello, welcome back to the Alchemist Library podcast. Today I had the pleasure of sitting down with Dr Abud Bakari. Dr Abud is probably the coolest doctor I've ever met. He is an incredibly unique individual and is so open-minded to exploring the more esoteric aspects of health. So I think you guys are really going to enjoy this one, because Dr Abud is grounded in science, yet he's so open-minded that it makes for a really unique individual. So it was an absolute honor to have Dr Abud on the podcast today. Before we get into this one today, I have a quick favor to ask you If you enjoy this podcast and if you enjoy what I'm doing here at the Alchemist Library, please leave a review. I don't like asking too much of you guys, because I'm really just trying to serve you, but the reviews really help the podcast grow and it is greatly appreciated. So that's all I ask for you guys today Catch you guys inside Peace. Are you doing this work to facilitate growth or to become famous?

Which is more important Getting or letting go?

So we had we did that Twitter space last night and your name came up because we were talking about how hard it is to find a doctor who is, one, open-minded and, two is somebody who actively seeks out this type of knowledge of talking about grounding and light, environment and non-native EMS, like all this stuff. How do you think you were able to, while being indoctrinated with so many of the traditional, which doesn't? Some are great, some are not so great, whatever, but what is? How were you able to? What was that foundation there? That made you very curious to begin with.

You know, I think it starts before you even enter, like you said, the foundation. I'm a bro first, I'm a gym bro first. I'm, first and foremost and second of all, I've always seen my pursuit of medicine as a path to figure out how the world works. It's not about buying someone's philosophy, it's not about memorizing different details. It's about learning how to think, learning how to examine the world, to understand how it works. And that, ultimately, is the reason I ended up going into medicine, because I was like, hey, this is the craziest system that exists on the planet and I'm going to figure it out. The human biology that is.

And one part of medical school that it's honestly a little tragic to begin with is the very unhealthy environment that it just makes you be a part of In terms of doing the night shifts and being under that bright light at one in the morning. How did you, how did you, balance that dichotomy? You?

know it's interesting, I tell people that the traditional system can't make you healthy. Because it took me. You know I enter into medical school. Into the first two years You're just on the books, you're doing whatever you want to do. And then the third and fourth year, in the hospital, you're under the blue lights doing the night shifts and what I tell people is that it took me from like 205 pounds, ripped and shredded, powerlifting competitor, to like gaining 20 pounds, 25 pounds, within a year. So even with the background of lifting weights and knowing how nutrition works and all these things, it's still inevitable that the environment that you're in puts you subconsciously in a state where you're ending up eating more, you're ending up sleeping less, you're ending up reaching for unhealthy snacks. So once I started realizing that, I realized I had to put boundaries around my life and set points to protect myself from the environment that I was in. So what were those? Yeah, good question. So I always put sleep first. That's like for first and foremost, you have to sleep, especially if you're coming off a stretch of really poor sleep. You're doing 28 hour shifts, nine night shifts, whatever it be. You have to have backup and catch up. You have to have some time where you're down. You have to realize that you've you've fried some dopamine receptors, you've messed up your serotonin levels, your leptin's out of whack and you have to give yourself time to recalibrate. So a lot of people will, you know, go on a stretch of nights and then they'll go out and then it's daytime again. So they want to live life and enjoy it. But you got to realize you got to slow down and allow yourself to recover. That's one. Two is absolutely positively cannot have that snacks around anymore, because what happens is you come out of a night shift, your leptin levels are messed up, your leptin is low, your ghrelin's high, your appetite's telling you eat, eat, eat and you crave junk food like you 've never craved junk food before. Oh no, my little pool thing is okay. My little pool thing was cleaning.

Oh.

I see another thing. I work outside. Now, like whenever I can I sit outside and work because indoor indoor lighting does not drive well with my physiology. I'm indoor all day. My eye appetite just goes through the roof. And like there's been too many times where I come home from a night shift and on the way home I'm picking up three pints of ice cream, a bag of chips and going for it. But now, knowing that those can happen subconsciously because of the ghrelin levels and leptin levels and all these hormonal changes that happen as a result of being in the hospital, I put rules around Okay, after I come out of shift, this is what I'm eating. I know exactly what I'm going to eat. There's no junk food in the house. There's going to be a high protein intake. I bring my food with me to the hospital, knowing what's going to happen if I just go to the hospital cafeteria or Uber eat something. And then number three is you've got to keep your exercise going. Like a lot of people, they fall off the bandwagon of exercise when they're in the thick of residency, in the thick of medical school. But you have to keep that muscle mass up. You have to keep the activity levels up. Otherwise you're just going to accumulate more fat, lose more muscle, especially with the way shift work. They've done studies where they put people on a caloric deficit and one group is sleeping less than six hours and one group is sleeping more than six hours and the group that was sleeping less than six hours end up losing way more muscle mass than the group that was sleeping more than six. So even though they were the same caloric deficit calories in calories out, all that stuff you hear if you're not in an optimal state when it comes to sleep, where those calories are extracted from will change.

That's so interesting I've never heard that study before and speaks to the power of sleep. It's something that's pretty fundamental to your work and stuff that you write about. And in that whole world of sleep, leptin, ghrelin leptin being the satiety hormone, ghrelin being the hunger hormone those get thrown out of whack. I mean leptin's, one that I've been very interested in, and the stuff you've been talking about with eating early in the morning, eating a lot of calories early in the AM to help sensitize your leptin levels.

Yeah, so I mean I traditionally used to do like the 12, 8 intermittent fasting, where you don't eat for the first eight hours of the day, you have a 12 hour window after that and then you don't eat again until the morning. That was my traditional way of doing things, but that was before I'm in the hospital and all these circadian disruptions happened. But the key circadian centers are your light, your food and your activity. Those are the three that call them zeitgivers and they are the ones that tell your body what time it is. So I have now shifted my protein intake earlier in the day and there's studies back up. They're talking about what they call early time restricted feeding. So you're restricted eating window. You could technically eat from like 6am to 5pm or you can eat from 12 to 8pm and the people had better results on insulin levels, glucose metabolism, all these things, and they shifted their eating windows earlier. And that's from the work of Satchin Panda and the circadian code and all these things. So because of my circadian rhythm being so vulnerable in my line of work, I have to set it with these zeitgivers. So that's protein first thing within an hour of waking up, light right in the morning I try to get my workouts earlier. I used to train at night now, and no longer training at night. If I have to train at night, I will. I'm not going to sacrifice my sleep, sacrifice my workout and be, you know, so crazy about it and so, you know, neurotic about the workouts. The workouts are still important but if possible I like to work out, you know, either early in the morning or like around 4 or 5pm when my body temperature is hottest, because your body temperature also has 24 hours circadian clock. It's highest, you know, probably 12 hours after waking up and lowest two hours before you wake up. So your performance is better when you're a little bit warmer. Your muscles are a better function, your proteins can contract your actinomycin and the protein fiber can bind better. That's why a lot of people, when they try to go for a world record or something, they go in the afternoon.

Hmm, that's so interesting. I don't think I've ever heard that before. Yeah, not eating from 8 to 12 versus not eating from past 5pm. I'm sure people hate to hear that because it's so much easier to not eat in the morning than it is at night. But, like, what's so interesting about that is if you're able to stick to it, because we are so prone to, like, in the evening, get that sweet tooth, you start to make worse decisions. Like, if you're able to stick with that, I think it's such a powerful way to stay consistent and the sleep quality gets better.

And sleep. When you don't eat three, four hours before sleep you go to bed, your body temperatures drop because digestion by default will raise your body temperature, especially your core temperature where your digestive organs are, you know, one to two degrees Celsius. Your growth hormone levels can start going up because growth hormone goes up when you are not fed. So in a fasted state growth hormone rises and a lot of people talk about that for intermittent fasting. That's why they don't want to eat in the morning. Growth hormone is not going to be growth inducing when you're in a fasted state because you need growth hormone and insulin together to release IGF-1. So the growth hormone we're talking about here is the growth hormone for recovery, for feeling better, for youthful energy. I mean just through the medical path. The bags under the eyes, the darkness under the eyes, increase because you're not getting that growth hormone production at night You're up late, you're not sleeping well and you're optimizing that growth hormone from 10 am Sorry, 10 pm to like 2 am. That's where your growth hormone is. Your soft scrown is more later in the night because you're getting more deep sleep early in the night and you're getting more REM sleep later in the night. So you really want to optimize that your sleep is at low temperature, high growth hormone production and then left to sensitivity too, because if you eat right close to bed time, you're throwing off your left to sensitivity and it's just not the optimal formula.

So interesting. I have written in front of me here as a note asking you about chronic anxiety for, like no particular reason, because I find that to be. When I have conversations with friends, and a lot of girls in particular, they have this, just these chronic, low grade anxiety, and you talk about the things that we were just talking about with sleep and just this disconnection with, like, nature and sunlight, all this stuff. What do you think the biggest drivers are for this chronic anxiety? Chronic, even chronic depression as well, epidemic that we're seeing?

What I always say about this is that it is not a surprise to me when people are depressed and anxious in the modern environment. It's more of a surprise to me when people are not anxious and depressed and I want to figure out why those people are immune, the default in the modern environment. if you combine our biology and you understand what the modern environment is, you add that together, you put that formula together and the result is anxiety and depression period. You're going to have low grade and anxiety going down no matter what. So when you come down to it, you have to realize what I call and I have a thought coming up about this the surfer to office worker spectrum. So surfer dudes, they're like, always relaxed. They're out in the morning on the beach, they're getting the sun exposure. They're grounded, they're doing physical activity early on, surfing. They're feeling good. They have this great energy going on and you rarely find mental disorders among surfers. I always go to the beach and talk to these guys and they're guys and gals and they're like the happiest people. They're relaxed. It's the magnesium in the water or it's the cold exposure early in the morning. There's a kidney rhythm. They're set. They have a purpose behind what they're doing. They're great. You come to the office worker, your traditional, whether it's the low level office worker or the executive that's stimuli on it. They're anxious, they're depressed, they're under blue light all day. Their sleep is crap. They're meeting with their shrink two to three times a month, they're not in a well state. So this is the spectrum. So the closer your lifestyle is to that surfer dude, the healthier you're going to be, and the closer it is to the office worker, the least healthy you're going to be and the more unnatural means you're going to need to put into your life to push you back to a healthy state, whether that's supplemental, medicinal, whatever it is.

It's such a great perspective. I love that spectrum because every we have this perspective of surfers being like the chillest, most relaxed people and no one ever makes the connection between the two.

Right.

Them just being in nature and living just a more connected life. It really is like, with that said, like with that information that you have, like knowing that stuff, but also being the doctor and being the person who's like indoors by, just because you have to be. What are the things that you can do to maybe supplements, maybe just certain lifestyles, which is easy, things that allow you to be closer to that surfer?

Yeah, so, um, this is. This is the things I've been trying to figure out, because my lifestyle is not anywhere near the surfer by default, I have to put in checkpoints to bring myself back to this. So, like this morning, I wake up, it's a walk at sunrise. The sun rose around six, 20 year in the morning. It's a walk at sunrise to the park, watch the sun, no phone. You're just kind of enjoying yourself, letting the thoughts that existed overnight and from the previous day kind of download onto your brain Ground. If you can, usually if it's sun's out and it's nice weather, I'll just drive down to the beach. That's not available to everybody, but if that's available to you, drive down to the beach, walk on the sand a bit, get in the water if you can. If you can't, you know just that. Walk in the morning. Most people, they, they. They get up in the morning and they're in the shower. It's artificial light in the bathroom. They get in their car the windows are up, the sunglasses are on, so they're not exposed to sunlight in their eyes or on their skin and they're straight to the hospital. They park in the parking structure, walk across still no sunlight. They're back into the hospital. A bunch of stress, bunch of notifications, patients are asking for things, the nurses are calling you and you've never allowed yourself to kind of naturally wake up and let your your cortisol rise, naturally, allow your thoughts to download from the previous night. Get that sun exposure. So that's number one. You have to get up in the morning. I tell people, walk wherever you are, just go for a little walk and see the sunrise. So you live and die by the sun. That's number one. Number two if you have a lunch break, take that outside. The lunch should should be done inside, under a blue light lit environment. Take it outside, get out of the hospital, read some fresh air and get that sunlight, if you can. Number three I like to watch the sunset if possible. So if you, whenever I was in the hospital, I would. I would joke to my interns that, hey, I'm going to go do some photosynthesis, and they'd be like what. And I, yeah, you go outside, you get some sunlight, you do walking at sunset. That's such a critical thing. It's like a 10 minute thing. You, you, everyone can put in 10 minutes just to go for a walk. You're getting your steps in and you're getting the sunlight exposure. So that's, that's like three for one. The other things to do is the more you are damaging your sleep, you're pushing your stress, the more exogenous compounds and things you're going to have to push on. So, whether that's ashwagandha for short stints, whether that's alfionine, whether that's taking more magnesium because the diet is so poor magnesium and all these things, these are the things you can add on to your life to kind of bring back the locus of calm to a better state as opposed to this constant stress.

Yeah, I mean I love that. I think that the first part, even just as simple as just the walks, it's so impactful and important and I mean I tweeted this the other day of just your mindset when you're on a walk versus your mindset indoors You're, you almost can't trust your thoughts when you're indoors sometimes because you have get a different perspective. But for the particular supplements that you mentioned magnesium and higher doses and we're not getting much of it in the diet ashwagandha and short stints, alfionine maybe how do you decide whether somebody, like if somebody asks you what supplements do I take? I know it's such a hard question to answer because there's so much individuality there. What, for you, is the indicators of I should be taking X, I should be taking Y? How do you know what to take for yourself?

I do not take anything daily. I don't have a supplement. That's daily. Besides, maybe, like lately, I've been adding cod liver back into my supplement stack just because I'm not getting enough vitamin A, but daily things. I don't have a daily supplement stack. I try to get my nutritional intake to be in the optimal state where I'm getting most of the things in. I like to use the supplements and I have like the supplement closet and I reach for things and I have like different baskets Like this is like how I'm going to do deport. This is going to if I'm going to be in a high stress state. This is going to be if I'm trying to really tailor in sleep or I'm switching between night and day. I have like different protocols that I go through. So what I like to do is I think everybody should know their big five personality traits, that's, neuroticism, openness, agreeableness, conscientiousness and extroversion versus introversion. If you know those five things, you can tailor the way you supplement around that. Like, if somebody is very low in neuroticism, they don't need an astro-gonda because they're already low in neuroticism. They need to be a little bit more neurotic so that they could get to the day. If somebody is hyper anxious, healthy and it makes sense. If somebody is already kind of that low energy, kind of not never excited, never energetic, they don't need to be taking alfine. So it really is by individual to your phenotype. You have to look at what the phenotype of your personality is and then tailor the supplement to that phenotype and that's just with a lot of self-experiment. And the person I would point to that's doing this amazingly is Noah Noah Ryan. He's just out there, he understands himself, he experiments and he's found what works for his biology.

It's an important note and I love that idea of having baskets of different things or different needs, just kind of protocol-ing your life, a bit Like having a protocol when you're high stress. Having a protocol and not just supplements, like in any regard, it's so important, it's a great note. I think this conversation of supplements kind of leads me into how we first got connected, which is lab work and the importance of that. That's something that I know you we're doing a lot of work in reading labs. Was there anything in that that made you just kind of bat an eye and be like damn, I didn't realize this was as big of a problem as it was.

Yeah. So the big things are. Let's break it down from a couple of buckets. Let's say the nutritional bucket, hormonal bucket and then the vitamin D light bucket. So we'll start with that last one. Everyone's vitamin D levels are low. Every lab that I hold on clinic patients, whether supplementing or not, the vitamin D is low. We know vitamin D low levels associated with the host of diseases. But the weird thing is when you do the studies and you give these people vitamin D as a supplement, their disease state does not improve and they're not protected from the disease. So people will shrug their hands and say you know what vitamin D doesn't work. That's not the answer. The answer is that there's a third variable, upstream of both vitamin D and the disease state that is influencing both. So if your vitamin D is low, it's something. You're not getting sun, so you're not getting your pom-C activated. You're not getting that IR light, you're not getting the UV light, you're not getting all these different things that are also contributing to the disease state. So the vitamin D is more of an indicator of what's going on rather than something we supplement aggressively and give you, because if you're not in the sun you're missing out on all those benefits. You're probably not exercising outside, you're not going on walks, you're stuck inside. That's probably predictive of you being on the computer all day, not doing meaningful things with your life, and it goes back to that. You know, surfer office worker spectrum. So that's an interesting one. Like it's rare for me to ever see a normal vitamin D level. We'll go back, working backwards, to the hormonal bucket and I've talked about this a lot that I see testosterone for men as a check engine light. So if you're, you have your underlying biology and you have your brain every day doing a calculation of how much testosterone you need to produce, and if that your biology and your environment are not matching up, your brain is not going to tell your testicles to make testosterone. So when I see a lot of testosterone in a otherwise healthy man, I'm like, hey, there's something under the hood. We need to investigate Whether that's the HPG axis, high-performance, the hypochlamic adrenal axis, the vitamin D levels, the sleep, the stress, whatever it may be. If someone's testosterone is low, a lot of the Twitter's video will tell you hey, just take Tangara Lee or take Fido Geoagrestis. But no, low testosterone is telling me that, hey, you have something in your biology that is not agreeing with your genetics and phenotype. So we need to address that and figure out what that is and allow your natural testosterone levels to come up. And if they're not going to come up naturally, we need to look at and see do you need treatment? Have you been exposed to radiation? You've damaged your brain, you've damaged your testicles, you've had concussions all these different things we have to talk about, and the general major things like oh, your testosterone is low, just take the supplements back and you'll be fine. When it's just telling me that there's something under the hood that needs to be investigated further. And then, moving to a nutritional perspective female patients chronically low in iron that's a result of menstruation and all these things. They're not getting enough iron in their diet. No one's eating livers anymore. People are being scared away from red meat, but the reality is we need these nutrients, we need iron, we need these B12, b vitamins, b6, all these things are critical to your biology and to act like we can just take a supplement for everything is so diluted. To add on to that, it's low levels of B12, especially in people that have the methanolate reduction deficiency. You can look at your 23 and figure that out Like maybe supplement with a methylated version of the vitamin instead of taking the regular vitamin. And this is all stuff that people just ignore, isn't really brought to view. To add on to all that, the normal ranges for all these labs are based on unhealthy people. So if you're normal based on unhealthy people, what is the benefit of that? Like? I'll give you a fun example my dad's testosterone is above 800 and he's in the 60s and I have my friends that send me their labs and their labs are like 300. So, based on the lab work, his doctor was like are you taking steroids? Like what's going on? He's like no, I'm just naturally living a life. My dad's always going on, walks, works out, runs three miles a day doing the healthy stuff that you'd want a 60 year old person doing. But my young friends that are in their 30s and 20s have testosterone that are 300 and 400 because their lifestyle is not agreeing with them and then, because of that, they've shifted the normal range down. So the normal range now in some labs like 250 to 850. And there's no way you're going to tell me 250 in a young man. For most cases it's normal. For some people they have very sensitive testosterone receptors. The endogenous receptor is so sensitive that even at 250, they're like doing amazing. But for a majority of young dudes 250 is not cutting and that level has just been moved down and they have like grandpa levels, which is ridiculous.

It's crazy. It's like it's that off of population data, not healthy cohorts, and then you think about how, like a lot of times, like throughout history, maybe now the sentiment is switching a bit, but the only people that were getting lab work to begin with were people who thought something was up. So it's this weird dichotomy. And then with the testosterone conversation, it's interesting because I find, like, when people ask me, like is my testosterone level good? It's 500. And I hear, like I hear this range often and I'm in my 20s, so it's crazy that it's this low. But between like 400 and 6 to 700 is like this range that I find most people in. When they ask me where it's like it's not low, but it's not optimal, and I mean there's just so many confounding factors there, it's like hard to get to understand. Like what is the thing to be doing?

Right, and that's why you really have to investigate the patient. Like someone messes me and asks me about testosterone, I'm like, oh boy, here we go. Because I have to really understand what is going on with this person. What's going on with their underlying lifestyle. Are they dominating society? Are they going and doing jiu-jitsu? Are they doing things that require competition? Are they sleeping enough? Are they not in a hyper stress out state? Are they eating enough? Are they in front of a TV all day? What is their lifestyle and what's going on? And there's so many different psychological, physiological factors that can influence that. And that's why I don't find testosterone to be the end all. It's more of an indicator to me, like, hey, we need to look underneath the hood. And it's great that we have four men, a great check engine, light lab test, because look at it. But hey, something's going on, let's investigate and look and see what the underlying thing is. And there's also the part of this that there's a industry around making men insecure about their testosterone, and that's the problem. There's the whole TRT clinic pill mill industry and supplement industry that wants you to feel that your testosterone is low so that they can sell you a product, sell you a service, push you on to something, so they can make money out of you. So that's the other problem. And there is no medium. The medical industry goes like, hey, your testosterone is normal. Normal is normal. Who gives a damn, we don't care. And then there's the online community, which is trying to sell people stuff that's like hey, your testosterone is low, let me start you on test epinate and you'll be good to go. But what we need to do and why I'm even on Twitter is that find this middle ground. Like, hey, if somebody has a problem, they need to be treated with TRT. By all means, let's do it. If we've worked everything up and looked for all kinds of different founders, let's do it. But if somebody just has a poor lifestyle and we need to fix that they have sleep apnea, they have whatever it is and we can get them back to normal, then let's do that also. But there isn't that nuance anymore because primary care doctors aren't trained on this Endocrinologists a good one is hard to find and the online community just thinks Phidogio, grestis and Tonga Ali and Ashwagandha is going to fix everyone's testosterone. It's so lacking nuance.

It's a lack so much nuance Like I was at this conference that Dan Garner and Andy Galpin put on. Someone asked them about TRT and Dan was like, yeah, I have no problem with TRT, but my bigger issue there is, like, why is the testosterone low to begin with? And it's always that first jumping point is, oh, low T. You're in your 40s. Let's get you on some TRT, which, like, obviously probably not a bad thing in terms of going to make you feel better, but what is the factor to begin with that's causing your testosterone to be low? It just makes for an interesting conversation.

Definitely. And the thing is we are entering the era of labs for healthy people, which is not something the medical industry is accustomed to, like we talked about. The ranges are mostly based. There are studies where they recruit random people, but how many people are even that healthy to begin with? The healthiest people probably like these surfer dudes we talked about. They haven't seen a doctor in like 20 years. They have no interest in seeing a doctor, so we don't know what their levels look like. I'm sure people have gone out and just recruited random surfer dudes that like, hey, let's check your testosterone levels and that would be interesting study. But we need to figure out what's going on. And we're entering the era of labs for healthy people because of people like Dan Garner and Andrew Huberman, who are telling people like you should get your labs. And I think it makes sense for every young man knowing that in your 40s you're going to question whether your testosterone levels are high or low and if that's the reason, your energy levels are low and your libido is falling off, it would be great to know what your testosterone was at 18. So that when you're 40 and it comes back at 500, where do you at 1000 when you were 18 and now you're at 500 and that's that drop off is why your symptoms is happening. Or have you always been at 500 and you've been running normally with that and other things in your life that are contributing to your testosterone problem? And that's when people are like, oh yeah, if you're healthy you don't need to check labs. Wait, hold on a second. I'm just going to be showing that you're going to be unhealthy someday. It would be great to know what the healthy baseline for you is.

And the thing about that too, which I'm curious your take on on labs for healthy people, because there's definitely a spectrum there and you could find yourself at times becoming a bit of a hypochondriac because of that and that's definitely an issue. But with the rights at eyes and with the right reference ranges, you could start to almost stop issues in its tracks or get ahead of disease. Like you could start playing offense with your health a little more. Where do you think that balances between freaking out over your health and being proactive with your health?

So there's two end points to the spectrum, rather. The first part is like don't get labs ever until you're in the ER and you have your first heart attack. And the second end of the spectrum is like hey, that's order $5,000 worth of labs and figure out what sticks, and both of them are probably equally bad. Maybe the get the $5,000 worth of labs is worse because you're gonna get a lot of false positives. What people don't understand is that, when it comes to all these labs, they are not the arbitrage of truth. It's not like if we check this lab, it's high, therefore this exists. Like you check a CA-99, it's a little bit high, you therefore have pancreatic cancer. It's like, no, these labs are each prone to bias. They each have a sensitivity and a specificity. If you don't understand bio stats and you don't have a provider working with you that understands bio stats, you can get in a world of hurt. Like you check a lab, suddenly you think you have pancreatic cancer. You're anxious for six months. You get a CT scan. There's nothing there, but you just ruin six months of your life and that's not great either. So it has to be understanding what are the good screening labs for your age group and what should you be looking at and what are the things that are high yield and then going based on symptoms and risk factors and family history and then looking at those specific things. Like I'm writing a thread right now about screening for cancer, which is what scares everybody, one of the hardest things to screen for. And I will touch on the fact that you don't want to just get random cancer labs and random imaging, because you can image your pancreas and maybe you've had a cyst on your pancreas since you were 12 and you never knew. And suddenly you image that at 35, you think that that cyst is a cancer. You end up getting a biopsy, you bleed during the biopsy, you're in the ICU for two weeks and now you need six months to recover and get back to normal. So, like, these things have consequences and we have to know when to pull the trigger and what triggers to pull. And that's the nuance that people don't realize because the traditional system doesn't want to talk about it. And the alternative some of the alternative people. They just want to use the shotgun approach Like let's just order everything, but it has to come to a center point where you're looking at the patient, seeing how old they are, what their family history is, and then pulling the trigger on certain labs.

It's such an interesting dichotomy. It's something I've been thinking about, as you know, with the lab work company that I'm trying to bring into reality. So, with that said very selfishly, like if you were to create something like that, if you were going to be in charge of trying to find that balance, obviously there's so many different packages based on whatever you want to test and for different types of people, but how would you go about having a person not having a person understand that this maybe isn't a perfect science and there's so much nuance to this that it's hard to explain in just this, just because you see this one biomarker that might be off?

I tell people that we don't look at biomarkers alone. We look at biomarkers in the global picture of what's going on for this person and what they're going through and what's going on Like. If you take me at the end of a 28 hour shift and pull testosterone level off on me, I'm going to be hyper gonadal. It's just the fact. But if you take a level after a week of, you know, walking on the beach every day in the morning and working out and eating healthy, I'm probably going to be at the top of the reference range. So understanding that is going to be key. The other thing is I like whoever I work with whether it's a client, patient or just random people that approach me at my gym and like, hey, I got my testosterone levels what do you think you have to understand? Bio stats. I think bio stats is the most important math that people need to learn in high school. Like, stop teaching people pre-calc and all these things. If they're going to become engineers, great, let's teach them pre-calc, but if it's just random people, understanding bio statistics is so important Because all of us are going to be exposed to these Yahoo headlines, these new stories like a new study finds that caffeine causes cancer. It's like wait, let's just look what the study actually looked at. Let's understand how these studies are being done. And Peter Tia has great work on his website about how to understand studies and I think it's called the studying studies series Studying studies, yeah, when he goes into, like how to understand studies, how do you read them, and if you're going to be exposed to study material online and you're going to be exposed to headlines. You owe it to yourself to understand how these studies work and how they're put together and what the bias is, what the positive predictive value, negative predictive value all these things are so crucial. So you have two options Either you opt out completely and say I'm not going to listen to any health information, or you're going to have to become health literate, and fast, because otherwise you're going to be soul things. You're going to be freaking out about things you don't need to freak out about. The other thing is there are good research studies that look into certain labs and see when you should be screened for things. For example, there's the US task force that looks in different screening labs, tests and imaging studies and they give recommendations Like if somebody comes in with a family history of colon cancer and their first degree relative got colon cancer before the age of, let's say, 55, then that person should get a colonoscopy at 40 instead of 45, like the rest of the population. So it's looking at those things and playing that out. The thing is, I feel, that we are rapidly advancing where people's health is deteriorating so quickly that we need to reassess these suggestions and look more and more aggressively. So, while this is not evidence-based, I feel that people should get, for example, a CDC every year or two. Why? Because, let's see, make sure that you're not becoming anemic, you're not developing some kind of lymphoma leukemia that we're not finding, and if we find it early, we can treat it aggressively and you can be cured. You said ZET right, yeah, yeah, complete blood count, complete blood count. There's no, I don't think there's any recommendations from any national societies that you should get a complete blood count every year. But hey, if we get, this is so crazy.

Right, because it's so simple and cheap, Like it's like 10 bucks Maybe less, Like I think four dollars Maybe less.

Yeah, yeah, four dollars Maybe, like I cost. Maybe they sell it for 10. But it's so cheap, but it's so useful because it tells me so many things right about. And I like to see a trend. I think where we're moving with lab work is that there's going to be lab work done and there's going to be some kind of algorithm that looks for a veracity that like hey, your white count has always been 6,000 for 10 years and suddenly now it's 12 or 3,000. And we need to look and just make sure everything's OK under the hood. That's how I approach it mentally, and some doctors are going to hate me for this. They're going to say like no, this is just getting too crazy, but I'd rather offer the patient something they can do and tell them there's nothing to do. And then they end up with some quack that charges them 20 grand for lab work that they don't need.

I mean it's true and it might seem a little extreme. I mean I would even say, from what I've seen with, I think it's every three months is at most what you should get in terms of lab work done. That is the. If you're doing it any more than that, you're going crazy. But at most it should be every three months of four times a year. That would be maximum. And if you were to do that, my thinking is, let's say you just get a CBC once every three months, it would be very hard correct me if I'm wrong to wake up one day and get diagnosed with stage three, stage four cancer.

Yeah, especially for the blood and lymphatic cancers. If you knew your CBC and probably you can add colon cancer in, because one of the presenting signs of colon cancer for older gentlemen is that they become anemic because they start losing blood in the stool. Yeah, here's a question that Peter T always talks about where he says if you did a colonoscopy on everybody every day, there would be no colon cancer. But that's not feasible. So let's find the intermediate point where we can get colonoscopies on people, because you do colonoscopy, you cut out the cancer. So if it were every two years, three years, would we catch all the cancers and then get them out, and then once again it goes back to risk family history. What's your diet look like and what are you doing? Like? If somebody is experimenting and taking different medicines and compounds and supplements, lab work more frequently might be better so they can see what's going on underneath the hood. If somebody is just in a steady state and they know what's going on and they're in tune with their body, maybe they can go out a little bit further. But there's simple labs and we can go into that if you want. Like simple labs that I think people would benefit getting and understanding for themselves and understanding how to read them, and that's the bottom line 100%, 100% and I want to dive into some of those for sure.

But I mean, I wonder what. It's such a weird place between this spectrum we've been talking about of hypervigilance getting neurotic, getting very hypochondriac, because I mean it is so easy to fall into that way of thinking if you're constantly testing at everything, like you put out the other day I don't know if you retweeted it or tweeted it, but it was kind of blew my mind if a test has 99%, do you know off the top of your head?

Yeah, so this is like the typical biostats first day of class question. That gets you interested into the subject, like if a HIV test has 99% accuracy, let's say which accuracy is kind of meaningless. We're talking about sensitivity and specificity, but we'll leave it there. Accuracy and in the population, only one out of 10,000 people have HIV. For sure. If you take a random person and check them for HIV, what's the chance that that person actually has HIV? If the test is positive, everybody needs your access. 99%, because if the test says so, it is so. But because the pre-test probability, the probability of you having HIV before the test is done, is 1 out of 10,000. It's so low that the chances of that being a false positive become so much higher Because out of the population, only one should have a test. So if you test everybody and you can go through the math, there's going to be, like, I think, two to 10 positive people and out of those people, nine of them are not going to have HIV. So understanding pre-test probability is so important, because all these studies, all these labs aren't looking at pre-test probability. For example, you get an HIV test on a population where 10 out of 100 people have HIV. Yeah, now you're going to approach 99% accuracy, because the incidence of HIV is much higher in that population.

It's crazy. So if you were to get tested for HIV and you're just some random person off the street and you were to get a positive result, there would be a 1% chance that you actually have HIV.

I think it ends up being like 50%, that it's accurate if we're using the 1 out of 10,000 rate. I think that's what ends up being like, when you do the math, two people would end up positive and only one of those two people would have it. So therefore it's 50%, and don't quote me on that. You have to look through the math in it and you have to plug in the numbers, depending on whether you say 1 out of 1,000, 1 out of 10,000, whatever it is. But that's why we have to do confirmatory testing and use a sensitive test and a specific test, and the majority of people listening to this are probably going to be like what is sensitivity, what's specificity? And they have no idea about this. But they're all consumers of health information, so you have to know.

Yeah, I mean one thing to that point that's getting a lot of notoriety lately, that I've been just I don't know where I fall in the spectrum of use case for, because I haven't done the deep dive and it's something that you have talked about, which is these peptides, particularly the ones for weight loss, the terazeppityde and semaglutide. What is your two cents when it comes to those, the? I mean it seems like everyone, especially older women, really have this desire to take semaglutide or terazeppityde. What's your two cents with that?

First, two things. I've used these compounds on patients in my former VA clinic and we've had great success, like I had people lose 100 plus pounds, like people not have to do knee transplants anymore, knee replacements anymore all these great things. But that being said, there's two spectrums here, as always there is the people want to put it in the water supply and want everybody to get this stuff so that everybody can lose weight. And there's people that say like no, no one should ever have a GLP one. Everybody should just die and exercise and lose weight on their own. It's just stop being fat and that. That's that. And the truth is somewhere in the middle. So these are powerful compounds. They they're GLP one agonist. They go up into your brain and tell your brain to get less. The bottom line that's how they work. They change your, your weight set point to a place where you are less prone to eating more and less prone to eating more junk foods, especially at the higher doses. Now, in an ideal world, if I could wave my wand, I could make everybody go out in the morning and see the sun and walk and exercise and everybody's healthy and nobody has food insecurity and nobody is forced to eat McDonald's because they can't afford to eat healthy and all these things and no one would be fat. The reality is we have a unnatural world and we need unnatural solutions. And I hate the word natural, just unnatural. It's just prone to a lot of junk in there. But but we have a unnatural world and sometimes we're gonna have to reach for unnatural solutions to those problems. So for a patient that's 400 pounds and has been trying to diet and I cannot diet because they are obese for 20 years in their set point and their weight is not that high and they're gonna have a hard time losing that weight and if they've tried everything, why not try a medication to help them out? Understand that these medications have risks. At the same time, there are risks to not treating people, like leaving that person at 400 pounds for another 10 years. There's a high chance they're gonna develop some kind of cancer, some kind of cardiac disease, metabolic syndrome, whatever it is. So we have to weigh the risk and benefits on both sides. That's where it comes from. Where I'm more skeptical of these drugs is for people that are like 10 pounds overweight and they want to take the drug just to get in shape and the way celebrities are using it and all these different people are taking it just for that purpose. I don't think that is worthwhile from risk-benefit discussion. So there's just nuance there that you miss on a 140 or 200-40% risk-benefit discussion. But the reality is we need to use all the tools available we have, for this epidemic, like the obese epidemic, is not going away. We can dream of a world where everyone's healthy, but that's just not the reality. So we're gonna have to see what tools we have available to us to treat these people and help them out, and that's the bottom line. I think you made such an important note about this.

We're in a natural world, so sometimes that needs unnatural solutions, and I think we have this tendency, especially the Huberman types, as some people call them, or just like the Twitter people. We have this desire for natural solutions and doing things holistically, and we have this desire for natural solutions and doing things holistically, in a way that's in accordance to nature. But that's something that the Ray Pete crowd really opened me up on understanding that this world is unnatural and sometimes that will result in needing unnatural solutions, and this world of peptides is emerging. It's really really quite interesting. It cracks me up. One of my favorite tweets from you that went megavocals, went mega viral, was if you were to provide a supplement stack for the president of the United States and you weren't concerned about consequences. You were only concerned about the eight years that they were in presidency and you were like going all out to maximize those eight years and then from there be a mess. It was so interesting to hear and to see some of those peptides being used, but are there any ones that you're particularly excited about?

Yeah, like we talked about, all these GLP ones are interesting, especially the GLP1, gip compounds are the GLP. Now there's coming out with the GLP1, glp1, gip glupagon triagonist, so it knocks all three receptors off, which is very interesting. Those are interesting to me because I'm interested in the melanotone and melanocortin pathway, so the leptin melanocortin pathway, pom-c, all these things. Melanotan is interesting to me, especially as it was first researched for females with libido issues because, interestingly enough, alpha-msh so pom-C is a pro, let's say a pro-protein that gets cleaved into several different hormonal pathways and it's activated by UV light from the sun. So, interestingly enough, one of those peptides that gets cleaved off is alpha-MSH, the lanocyte-simulating hormone, and we know that animals go into heat in the summer because of increased exposure to sunlight and humans also respond positively to MSH. So a lot of people with their libido isn't a testosterone issue, it's an MSH issue. So when scientists noticed this, they studied melanotan for this purpose. It never got through FDA approval fully. I think there was concerns about safety versus efficacy, versus people wanting to inject this every night for libido, blah, blah, blah, blah. But it blew up in the bro space for tanning and for libido reasons, like CT141, melanotan2 and all these different peptides. They're interesting to me because they are being used like crazy and nobody is studying it, nobody is examining it, nobody is tracing what's going on. And there's another part to these peptides that many of them fall under this murky category of can't be patented versus can't be patented. So the FDA keeps changing the rules of how many amino acids the peptide has to be for it to be patented versus not. So whether it's PPC157, melanotan, tp500, it's so hard to study it. Number one nobody is studying it. We can be conspiracy theorists and say why are people not studying it? Or you can say that no one is studying it because it doesn't work. I'll leave that for the viewer to decide. But it's a weird space. The health online community is going to drive the space more than the medical community is. So ideally somebody would put together some kind of research on it, but it's just going to be anecdotal. It's going to be reddits and forums and Twitter posts that blow up, like Newbro or whoever it is that starts talking about this stuff. But to answer your question, yeah, I'm interested in the MSH pathway hormone peptides. I'm interested in the regenerative ones, like PPC157. Ppc157 is coming out because if it is as good as people say it is, then we need to know more about this. If it actually works and it helps people with their joints, with their injuries, we need to know. If not, we also need to know, because then we should move on to other targets, like whether it's PRP or stem cells, whatever it is, and it's unfortunate that we don't have the answers here it's funny because it kind of goes back to the bodybuilding crowd and obviously there are some of the people who are the most brave when it comes to testing this stuff.

It's funny that we have a lot of literature on testosterone and some of these compounds from that crowd. They really are the drivers of a lot of innovation in that space and understanding. It's interesting to see and for me I'm particularly interested in the autoimmune, auto-inflammatory type of space, just because of personal experience and I have seen some people say that the commonly used drug is like Humera but that you could totally replace Humera and get a much better effect and a much safer effect with something like thymicin alpha 1, or it was thymicin alpha 1 and maybe TB500 could use in combination, that's what people? talk about. Yeah, go on. What do you think about that type of stack?

here's what I think about it. What I think about it is I want to know the answer, and it's unfortunate that we don't know the answer. I want someone to do the study because, if it is true, first of all, humera is super expensive and there's a lot of risk factors that go involved with it. You're suppressing your immunity as a result and there's consequences to these drugs. Don't get me wrong. They can be life changing for people. Somebody who has crippling rheumatoid arthritis. They get on this drug and suddenly, hey, now they can get up in the morning. But if there's a better alternative that isn't as side effect prone, let's know about it. We need to know and it's unfortunate that this research isn't being done and you go to a traditional doctor and they're going to brush you off like, oh, this is nonsense, it's not real.

But maybe it's not real because nobody can make money off TB500 and thymicin alpha, maybe because there's no incentive to study it, while there is incentive to study Humera and infliximab and adeluma map and all these different drugs so as a clinician, I mean I know that you're kind of just getting started on this journey, but how are you going to help guide patients and decide whether it should be if someone comes to you and they're that person with really bad joint pain and rheumatoid arthritis? How do you understand, like, where to fall on that spectrum in terms of natural solutions or maybe some of these more innovative new type stuff that isn't as well studied, versus the drug stuff? Because I mean, it's scary the malpractice could be like. It's something that you obviously have to worry about, especially when you're when you're going against the book at times. So what do you? Where do you fall in that spectrum?

Yeah, like you said, if I want to keep my medical license, I cannot disregard the whole rheumatological community and they do great work. I'm not going to discredit the fact that they do give people their lives back with these drugs. They do. They do change people's lives and I've seen I've seen it firsthand where a patient has severe lupus and they get treated and now they're back to normal. There are consequences with the drugs, but, like we said, but their life is much better and I'm glad these drugs exist. The question is can somebody reverse their autoimmune disease? Can they make complete change? Can they decrease their symptoms based on their lifestyle, like we talked about circadian rhythm, getting that sunlight, eating healthier, getting rid of processed food and finding what triggers their autoimmunity. Can that work? We want to know the answers. So, as a clinician, what I look at is I will lean on my colleagues in the different specialties and I won't tell somebody to disregard what the specialty has given forth. At the same time, if a patient is adamant about experimenting something, I won't. You know I hate this paternalistic aspect of medicine where, like I, as doctor, must tell you, as the patient, what to do and you must follow my commands. It's very old school and it's not the reality of the situation. If a patient insists that they're going to try something and I'm not going to be able to convince them otherwise, I'll say hey, you try it, I'm going to monitor your labs and I'm going to monitor you and look out for symptoms and help you on that. I might not agree with what you're going to try and I don't know if it's going to work, but if you're going to do it, at least let's do it safely. Like I know a lot of people that use steroids, for example, and I'm like, hey, this is probably a bad idea, trend doesn't belong in your system. But if you're going to do it, I'm going to check your, your CMP and look at your liver markers every three to six months because we need to see what's going on. So I think that fine balance of like, hey, as a clinician I can't make decisions for you, but I can look out for your safety and I guess that's where I could be at most help and at the same time I am looking for the signal to noise ratio on these different things. Like I look very closely like if somebody starts saying like there's a lot of tripping around about BPC being good for XYZ thing. I will look and I'll see if there's any good data. I'll talk to people in the field, I will maybe do some self experimentation on my own, see if these things are worthwhile and then bring that forward. Unfortunately, though, especially after the last three years, the regulatory environment is such a way that I am handcuffed a lot of times, and you can read between the lines and know what that, what that means.

Man, it's a shame. It's a shame. It's also a shame that you live in California and I can't use my primary care physician. I need a good doctor, man. It's so funny. It's like I haven't really gone to a doctor in a while because I kind of monitor my own labs and, right, explore myself. But I mean that's obviously not like the best thing to do and I should have a good primary care physician, right, but it's hard to find someone who gets it or to what will won't belittle you. Do you know what Like I hate?

that I've had patients come in and tell me crazy, crazy stuff. I'm like, okay, tell me about it. Like, what are you doing? Instead of shutting you down, telling you like, hey, well, you're doing stupid, I want to hear about it. And that way, like if you tell me you're taking XYZ supplement and I know that supplement is prone to causing liver failure, I just can tell you okay, if your eyes start turning yellow, stop the supplement, call me and let's check labs. Like so I can at least navigate you through that, because I can't control what the patient does when they leave my office and I'm not going to try to control what they do. I can just give recommendations and guide the patient on the path. And you bring up a really good point. I think that preventative care is done with having a doctor who can get you to your lab work, screen you for things, kind of guide you on the path. But it falls back on the patient and I love what you're doing, where you're self aware, you understand labs, you understand how things work and you have to focus on your own health. Like a doctor is not going to hold your hand and take you to the promised land of health, it's just not going to happen. It has to be you as a patient. Take ownership of your health and go forward, because we've seen what happened in the last 30 years when we were trying to depend on the medical system to make it healthy. The medical system is not going to make it healthy, it's not saving you anytime soon, and that's just the reality of the game.

It's a sad reality of the game and I mean, I feel for the people who don't have this baseline knowledge and like, honestly, if I didn't have the experiences of being forced to kind of explore and like learn for myself, I probably would never know and I never really go deep into this thing. And this next generation of like essentialized medicine and medicine 3.0, like it's going to be an interesting thing to see how it evolves, with one artificial intelligence and two, just this more holistic, maybe more precise way of going about things. It's an interesting thing. I'm curious what your thoughts are in terms of the evolution, and I know you're a big fan of this decentralized approach. What is that and where do you see it going?

Yeah, this is a very popular thing to Dr Jack Cruz, who is this neurosurgeon turned let's call it light expert, who focuses on the way that we as what do you mean? I guess he referred to us as light driven beings, and that has both physical and metaphysical meanings to it. Let's just say leave it there. But he is advocating for leaving the centralized platforms, leaving the big institutional stuff, and independent doctors with patients making decisions that are best for everybody, and that's it's similar to the Bitcoin approach, where you can have a centralized approach where, with essentialized Federal Reserve that prints money, or you can have decentralized approach where Bitcoin nobody can control it, it's a decentralized entity and that everybody has their own invested stake in the entity. And I think this is where we're moving, and the way I look at it is that the patient must be the locus point of the health. It cannot be the clinic, it cannot be the hospital, it must be the patient. And thanks to the internet, thanks to AI, patients are going to have more information at their hands and they're going to be able to make decisions for themselves. And that's where I think the decentralized medicine goes, that we need to empower people to make the best decisions for themselves because we like we talked about the whole time the defaults. If you leave yourself your biology in the system, you will crash. It's like it's like running a computer and throwing it in a pool that put the computer will short circuit. It's just the reality. So we must give people as much information and as much useful tools and luckily we live in a, you know, catholicist consumer society and there's bad things to that. The good thing is, the good tools will come forward. If somebody comes out with a great AI that can do all these things, they will be. They will be rewarded from a system standpoint. So we have to be allowed to happen, especially because now the gatekeepers are gone, especially after the pandemic, people won't trust the people like me anymore. They don't trust the system. So there is a loss of gatekeeping, which is going to have pros and cons. You have quacks, they're going to profit office and there's going to be people that are evidence based. I feel like, in a very weird way, twitter, being decentralized, can pick out the quacks so beautifully. There are people on Twitter that are blowing up their accounts, take off and people kind of self check. There's decentralized nodes within the community that say, hey, this is a good account, they have good information, or this is bullshit. Don't listen to this person. What decentralized moving with medicine, I think. Decentralized religion, decentralized medicine, decentralized finances all these things are better because you don't want some guy in a king's chair dictating on down everybody else. Hey, you must do this. This is the only way, because that's prone to corruption.

I mean it's crazy, the decentralized approach. There's definitely so many benefits there. I mean I think about the example of like farming and end of just a grocery stores. How much healthier we would be if we had like a decentralized approach instead of this like massive monopolized thing. Dr Abad Bakar is there? Before we end this here, is there anything else that you think is either fundamental or have been front of mind lately that you want to quickly touch on?

Yeah, I think understanding that you as a human being are a clock and every cell in your body is run on a clock, and understanding that you will be a different person at different times of this clock is the first pathway to starting your health care. And everything starts and ends there. And if you don't believe me, just go to the hospital at 1am and look at the faces of the doctors and the nurses there. Bless their souls. We need them to be in the hospital, but they have aged 20 to 20 years over their stated age because they're out of sync with their natural clocks.